Provider Demographics
NPI:1689836959
Name:THERESE S. BROWN, PA
Entity Type:Organization
Organization Name:THERESE S. BROWN, PA
Other - Org Name:THERESE S. BROWN LMT
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESE
Authorized Official - Middle Name:SHOEMAKER
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:321-302-9885
Mailing Address - Street 1:140 BELLWOOD ST
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-8134
Mailing Address - Country:US
Mailing Address - Phone:321-383-8585
Mailing Address - Fax:321-383-8264
Practice Address - Street 1:3270 SUNTREE BLVD
Practice Address - Street 2:SUITE 126
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-7530
Practice Address - Country:US
Practice Address - Phone:321-302-9885
Practice Address - Fax:321-383-8264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty